Feasible E-Health Strategies to Reduce Maternal Mortality in Kenya

Feasible E-Health Strategies to Reduce Maternal Mortality in Kenya

Richard Charles Millham (Durban University of Technology, South Africa), Israel Edem Agbehadji (Durban University of Technology, South Africa), T. Puckree (Durban University of Technology, South Africa), V. Mukami (Africa Nazarene University, Kenya) and Tengyue Li (University of Macao, Macao)
DOI: 10.4018/IJEACH.2020070103
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Maternal mortality remains a persistent cause of death in Sub-Saharan Africa. Although e-health technologies are rapidly advancing, many technologies are infeasible given the infrastructure constraints and context of Sub-Saharan Africa. This paper proposes and implement a feasible e-health strategy, which involves the use of simple mobile phone technology and was designed to reduce maternal mortality and neonatal rates through information dissemination, among the nomadic people within a select part of Kenya. This strategy was developed, through an interactive pilot study, to determine the most feasible technique, which was found to be SMS messages, and most appropriate customized information depending on the patient's condition and period in pregnancy. A cross-sectional randomized e-health intervention was implemented in order to determine the effectiveness of the intervention. Due to exceptional circumstances, such as a prolonged health strike, this intervention had mixed results but shows promise of both feasibility and effectiveness.
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This paper examines the effect of an ICT intervention on several factors including neonatal deaths. Neonatal deaths can be defined as the death of the fetus or baby during labour and/or delivery. In order to understand the relationship between neonatal deaths and maternal mortality, which is defined as the death of the mother during or shortly after birth, one must be aware that the death of a mother produces a much higher likelihood that her new-born infant will die within their first two years (Atrash, 2011); hence, the need to reduce both types of death rates. Deaths, both neonatal and maternal, are not spread evenly throughout the world [2] with developing countries accounting for 99% of these deaths worldwide (World Health Organization, 2016a). The sub-Saharan African region accounts for the world’s highest rate at 66% of the world’s maternal deaths. (World Health Organization, 2016a).

The majority of these sub-Saharan countries have not been able to lower the maternal mortality rates (MMRs) to the level of the World Health Organization (WHO) recommendations. Within this region, eighteen nations have very high MMRs varying from 999 to 500 per 100 000 live births as opposed to the WHO goal of below 70 per 100 000 live births. Sierra Leone, one of the member states had the highest MMR in both the region and globally at 1360 deaths per 100,000 live births (World Health Organization, 2016b). Eighteen other nations, all in Sub-Saharan Africa were estimated to have very high MMRs ranging between 999 and 500 per 100,000 live births as opposed to the WHO goal of below 70 per 100 000 live births. Kenya is among these nations with the MMR rate at 687 in 1990 and at 510 per 100 000 live births in 2015. Despite this reduction in MMR, it is a fraction of the WHO goal World Health Organization, 2016b). Poor women in isolated areas are the least likely to obtain adequate maternal care (World Health Organization, 2016a).

In order to resolve these national and social health inequalities, Information Communication Technology (ICT) may be effective provided that ICT is guided by an awareness of their target population’s literacy levels and that ICT accommodates cultural differences among populations. (Latulippe et al., 2017) Furthermore, the impact of ICT is greater if it is focused on the target country’s problems, reliant on its infrastructure, and suitable to the local situation. (Musoke, 2002) The rapid adoption and use of mobile telephones, as technological tools, by millions of Africans as technological tools due to their moderate affordability, portability, multi-functionality, and relative ease of use (Banks, 2008) provides a powerful and commonly available tool to utilize to address health problems.

The rise in the adoption of mobile phones has produced many Mobile Health (mHealth) interventions in developing countries, specifically in Sub-Saharan Africa (Tomlinson et al., 2013). These mHealth interventions are viewed as a way to improve the well being of the populace while lessening the cost of healthcare.(Kumar et al., 2013). MHealth application vary and include care delivery, communication, and improvement of point of service data collection (Tomlinson et al., 2013). One of mHealth’s greatest limitations is the lack of consistent data on the implications of mHealth intervention (Kumar et al., 2013)) which does not provide a foundation for evidence-based scale-up (Tomlinson et al., 2013). Although this foundation may be lacking, a few trials have been piloted that have demonstrated that mHealth remains a prominent technological advancement tool.

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